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Home My WebLink AboutPermit Electrical 1990-2-19 [INSPECTION LINE 11726-3769. I Job Address I\/~ Legal De~crlptlon ~ 5 lj-tk. "f- 7/IIltU/IL T;61S" N\~\n \1 Od.~?' ~ d D63D \ Owner Sfrrr~ Of DrJ.{>>ON Address5mrt 1!III-flS!JoR1ftriNJ tJ/nG , Sf/-L~f1II, [) It. CITY OF SPRINGFIELD C0I1BINATION APPLICATION/PERMIT EIIERGY SOURCES Heat I'later Heater y~"~.~ I NFORI1ATION 1I NI:. 726-3753 Sq. Ftc). 11aln :q. Ftg Access. Sq Ftq. Other He\~ Add Alter Pep. --Fence Demo Change/Use --Other - - ~ Ranqe ValuE of Hork 8 $L) o cr. Address DESIGN TEAt~ , PI n/3'/ ?/// BuilcllnQ Pernnt Info Descnbe Work(l.e., BUlld lon'U(){r) , /I{J/l/ Family Resldence 111 th /lttached Garaoe) /}iQ~t)\~-tt~-~ "i; ~ Qr\\Q ~J.I ) \ "J - ~\ V Slngle : Constructlon Lender (name) Phone (address) (llCS no) (exrll res) (phone no I Prlmary Structural El ectrl ca 1 i----- 11echanl ca 1 , CONTRACTORS (name) I General L. R. f>RI1I)HfHMINB., . I (address) (llCS lD-1) W, \I(J" ;:;rr~:e-rr .5~tD.DjQ Cj'7L/-ll " . I . no ) (exPlres) :tD87C- 10/;/90 / I (ohone no. ) 71.f7,663f Plumblnq ; Electrlcal I : ~lecha nl ca 1 PLUfm I NG ELECTRICAL MECHANICAL , NO. FEE I CHARGE NO_ FEE CHARGF NO FFE CHAR(;F SO. FT furnace/burner to BTU's Each slngle flxture Resldence of Relocated bUlldlng (new flX. addltlonal) New clrcults alts or extenslons Floor furnace and vent S.F. Resldence (1 bath) Duplex (1 bath) each AddltlOnal bath SERVICES ~tUW~ -fo fro A-rn~ /./3 k).W Recessed wall Space heater and vent Sewer Temporary Constructlon Chanqe ln eXlstlng, resldence multlfamlly, comm. or Industrla 1 Of amps I COMI-l./IND. FEEDERS I IInst~ll/alter/relocate I dlstnb feeders 10f a~p~1 I I I I Appllance vent separate Statlonary evap cooler Vent fan wlth slna1e duct Vent syste~ apart from I heatlna or A.C. Mechanlcal exhaust hood and duct Wood stove/heater HaLer serVlce Storm Sewer I SSlJANCF OF PFRf1IT TOTAL CHARGfS TOTAL CHARGES c??;r,U7~ TOTAL CHARGES WHERE STATE L '\I~ REQUIRES that the Electrlcal work' be done by an rlectncal Contractor, the electncal portlOn of thlS permlt shall not be vallJ untll the label has been s1qned by an Electrlcal Supervlsor and returned to the BUlldlng D1V1Slon , I HAVE CAREFULLY EXAt11NED t1e completed appllcatlon for aermlt, and do hereby certlfy that all lnformatlon hereon lS true and correct, and I further certlfy that any and all work performed shall be done ln accordance wlth the Ordlnances of the Clty of Sprlngfleld and the Laws of the State of Oregon oertalnlng to the work descnbed hereln, and, that rw OCCUPAIKY wlll be made of any structure wlthout the permlSS)On of the BUlldlng D1V1Slon I further certlfy that my reqlstratlon ~l1th the BUllder's Board lS ln full force and effect as requlred by ORS 701.055, that lf exempt the basls for exemf"ltlOn lS noted hereon, and that only subcontractors and employees who are ln comDllance wlth OPS 7"1.055 \/111 be us~d on thls nroJect. Zone Flre lone Flood.Plaln Type/Const. Bedrooms S tOrl es Unl t s Occy Load Occy Group I SI(;NATURE For OFFICE USE ONLY Sf]. rto. r1aln Sq. Ftg Access Sq Ftg. Other ~~ #-dJ_; ~~~E 2//9/9tJ , (, IW1E(please prlnt) 7i!fJ Lf1-N,Z- x Value Value Value x x TOTAL VALUATION PLur~BING PERMIT Charges and Surcha rges Plan Ck Comm/Ind 65%/BldQ Per Fee Plan Ck. Res 30%/Bl dq Per Fee Fence Systems Development Charqe (1.5:r:j BUILDING PER~1IT Charges and Surcharges ELECTRICAL PERflIT Cha rges and Surcharges I D/}mo ~ ~ . ~ I Sidewalk - -- t-r-r.s-,-, A/C Pavlng I Curb Cut I r I I I ITotal Comb Permlt I I TOT~\L {)3.fJ3 MECHANICAL PERMIT Charges and Surcharges ,^ "\ COMBINATION APPLICATION/PERMIT (CAP) I. II Appllcant to furnlsh A. Job Address B Legal Descrlptlon 1. example- Tax Lot 100, Lane County Map Reference 17 03 43 2 example- Lot 1. Block 3, 2nd Addltlon to Sprlngfleld Estates C. Name, etc. of owner and constructlon lender D Energy Sources 1 example- heat/electrlcal celllng/or forced al~ qas 2 example- waterheater/electrlcalior solar E Square footage or valuatlon, etc 1 example- 1250 sq. foot house, 500 sq foot garage 2 example- lf new proJect, check-nEw - lf addltlon, check add, etc F. BUlldlng permlt lnformatlOn 1. example - construct Slngle fa~lly house wlth an . attached garage 2. example - remodel eXlstlng garage lnto famlly ,room 3. example - convert slngle fanllly resldence lnto restaurant (change of use) G. Value of work as deflned ln Sectlon 303 (a) of the Structural Speclal~y Code , H. DESIGN TEAM AND CONTRACTORS To avold deslgn or constructlon delays, BUlldlng Dlvlslon Staff must be able to contact approprlate persons regardlng deslgn lnformatlOn or Job sHe correctlons, etc. Abbrevlated Plumblng, Mechanlcal, & Electrlcal Schedules A. Except where blank spaces occur ln the descrlptlon portlon of the Mechanical and Electrlcal Schedules, the appllcant need flll-ln only the No Boxes adjacent to the approprlate ltem(s) to be lnstalled B. Full Plumblng, Mechanlcal, and Electrlcal Schedules are avallable at the BUlldlng Dlvlslon 1. To conserve space on the perrm t form the schedul es have been abbrevlated ' 2 If the ltem(s) to be lnstalled are not covered on the abbrevlated schedules you should consult the full schedules C. BUILDING DIVISION STArr WILL FILL OUT ALL FEES AND CHARGES ON THE SCHEDULES D. As noted on the CAP, the label must electrlcal contractor for slgnature supervlsor. The general contractor to slgn the electrlcal label Appllcant to slgn and date Whenever posslble, the lnltlal appllcatlon wlll b~ used as a worksheet only Where posslble, BUlldlng Dlvlslon Staff wlll prepare a type wrltten copy and return lt to the appllcant at the tlme the actual permlt lS lssued for ,hlS slgnature Fees and Charges Plan check fees are due and payable at the tlme of the appllcatlon, and no plans wlll be processed untll the~e fees are pald All other fees and charges are due and payable when the permlt lS lssued. PERMIT VALIDATION 1 \ i , i be dellvered to the by hlS electr~cal lS not author~zed III. I V. V FOR OFFICE USE ONLY W /lv {-~ . 0 cD jJ } J ~ I t: \ I , , " Permit cledtW_) _____..~,...~"Il'7'" ~......._.._,..... ._.l7TW.lT.,~--- ..-.- ...---- Additional Project Information: PLANS REVIEWED BY: name signature PROJECT CONDITIONS TO BE SATISFIED BEFORE OCCUPANCY: f , ) , I Permif applicant exempt from registration' ~ith the Builder's ~oard because: -- ....u. ~~ Jdate .